Pulse Check Decisions

Slides by Josiah Sitemeung, Alex Ryden, Brian Locke

Pulse Check Decisions

Scenario

Code Blue on E50.

Compressions ongoing on arrival

You establish yourself as the code leader

Next steps?

Scenario: First Pulse Check

No palpable pulse

Rhythm strip during initial pulse check

What’s your next step?

What to do when you’re uncertain?

Coarse vs Fine Ventricular Fibrillation

Turn up the gain; Enroll help: “Are we certain this is asystole?”

Scenario: Second Pulse Check

No palpable pulse

Second Pulse Check

Anesthesia ready to intubate, asks for a moment before resuming compressions

What is the big picture?

Only a few things matter

  1. If they don’t have a pulse, someone is performing high quality compressions with NO significant breaks

    • Limit pauses (position changes, pulse checks, intubation, Lucas)

  2. Shock early when they have a shockable rhythm

Zoll Feedback mode

Scenario: Ongoing CPR

RN: “I’m having trouble getting a pulse even during compressions”

How else can we detect ROSC?

  • EtCO2

  • POCUS(?)

  • Doppler

  • When in doubt, continue compressions

EtCO2

EtCO2

Use EtCO2 to help detect ROSC

Scenario: Third Pulse Check

ROSC

EtCO2 = 36

Summary:

  • DO NOT MISS FINE V.Fib

  • Only allow, at most, a few seconds of CPR delay for intubation/Lucas

  • Use EtCO2